week 1 optional learning objectives Flashcards
What controls the synthesis of RBCs in the bone marrow?
Synthesis of RBCs in bone marrow is controlled by erythropoietin (EPO) produced in the kidneys.
Where is erythropoietin (EPO) produced?
EPO is produced in the juxtaglomerular apparatus of the kidney’s afferent arterioles.
What are reticulocytes?
Reticulocytes are immature red blood cells that retain some protein synthesis capabilities.
Where do reticulocytes live before becoming mature RBCs?
Reticulocytes live in the bone marrow for ~3 days and finish maturing in the peripheral blood for one additional day.
What is the lifespan of a mature RBC?
The lifespan of a mature RBC is 110-120 days.
What are key aspects to investigate in a patient’s history when assessing for anemia?
Key aspects include dietary habits, medications, chemical/toxin exposure, family history, previous blood tests, and bleeding history.
What symptom onset might indicate anemia due to rapid blood loss?
Patients with rapid blood loss will have more severe symptoms due to less time for the body to adapt.
Name three common symptoms of anemia.
Fatigue, muscle weakness, and headache.
What is Koilonychia and which type of anemia is it commonly associated with?
Koilonychia is spoon-shaped nails, commonly seen with iron deficiency anemia.
What is the normal reference range for hemoglobin (HGB) in adults?
The normal range varies, but generally <13 g/dL in men and <12 g/dL in women is considered anemic.
What does MCV stand for and how is it categorized in anemia?
MCV stands for Mean Corpuscular Volume and is categorized as normocytic (80.0-100.0 fL), microcytic (<80.0 fL), and macrocytic (>100.0 fL).
What does MCHC stand for and what does it measure?
MCHC stands for Mean Corpuscular Hemoglobin Concentration and measures the ratio of hemoglobin mass to RBC volume.
What does a high MCHC indicate?
High MCHC (>36 g/dL) can indicate spherocytosis, and is sometimes seen in sickle cell anemia and hemoglobin C disease.
What is anisocytosis?
Anisocytosis is the variation in the size of red blood cells, often seen in anemia.
What does a peripheral blood smear test for?
A peripheral blood smear tests for abnormalities in the morphology of red blood cells.
What are acanthocytes, and what do they indicate?
Acanthocytes are spherical cells with thorny projections, often seen in severe liver disease, abetalipoproteinemia, and post-splenectomy.
What are echinocytes (burr cells), and what conditions are they associated with?
Echinocytes are spiculated red cells associated with liver disease, uremia, and pyruvate kinase deficiency.
What do codocytes (target cells) indicate?
Codocytes indicate hemoglobinopathies, thalassemia, obstructive liver disease, or post-splenectomy.
What are dacryocytes (teardrop cells), and what do they suggest?
Dacryocytes are elongated RBCs with a pointed end, suggesting myelofibrosis or severe hemolysis.
What are Howell-Jolly bodies, and when are they seen?
Howell-Jolly bodies are DNA remnants in RBCs, seen in patients with splenectomy or functional asplenia.
What does a bone marrow biopsy involve?
A bone marrow biopsy involves aspiration of liquid bone marrow for examination, often used in cases of severe pancytopenia or suspected bone marrow infiltration.
What is the first step in the workup of microcytic anemia?
The first step is to rule out iron deficiency anemia using tests like ferritin, serum iron, and TIBC.
What is the definition of microcytic anemia?
Microcytic anemia is defined by an MCV (Mean Corpuscular Volume) of less than 80 fL.
What conditions are associated with increased levels of reticulocytes in microcytic anemia?
Conditions include hemorrhage, hemolysis, and thalassemia.
What causes sideroblastic anemia?
Sideroblastic anemia is caused by a failure to incorporate heme into protoporphyrin, leading to defective hemoglobin synthesis.
What conditions are often responsible for macrocytic anemia?
Common causes include B12 and folate deficiencies, liver disease, hypothyroidism, and certain medications.
What is megaloblastic anemia, and what are its causes?
Megaloblastic anemia is characterized by macro-ovalocytes and hypersegmented neutrophils, typically caused by B12 or folate deficiencies.
What are the symptoms of vitamin B12 deficiency?
Symptoms include paresthesia, decreased proprioception, spasticity, and altered mental status.
What are the causes of anemia of chronic disease?
Causes include chronic infections, cancer, autoimmune diseases, and diabetes mellitus.
What are the lab findings in anemia of chronic disease?
Lab findings typically include low serum iron, high TIBC, normal or high ferritin, and low reticulocyte count.
What are the different types of hemolysis?
Hemolysis can be microcytic, normocytic, or macrocytic and can be immune-mediated or non-immune mediated.
What is the role of the Direct Coombs test in anemia?
The Direct Coombs test detects the presence of antibodies or complement on RBCs, indicating autoimmune hemolytic anemia.
What is the treatment for warm antibody hemolytic anemia?
Treatment includes corticosteroids like prednisone, and in some cases, splenectomy or rituximab.
What are the signs of anemia related to jaundice?
Jaundice, particularly scleral icterus, can indicate hemolysis.
What can thyromegaly indicate in the context of anemia?
Thyromegaly may indicate hypothyroidism, which can be associated with anemia.
What is the significance of lymphadenopathy in an anemia workup?
Diffuse lymphadenopathy can indicate malignancy.
What does an enlarged spleen suggest in anemia?
An enlarged spleen may indicate chronic malignancy or portal hypertension from chronic liver disease.
What is the significance of low MCHC (<32.0 g/dL)?
Low MCHC typically indicates hypochromic anemia, often associated with conditions such as iron deficiency.
What is the primary treatment for vitamin B12 deficiency?
The primary treatment is B12 replacement, either orally or via injection.
What are basophilic stippling cells associated with?
Basophilic stippling is associated with lead poisoning and thalassemia.
What does an elevated reticulocyte count (>3%) suggest in the context of anemia?
An elevated reticulocyte count suggests a response to blood loss or hemolysis.
When should a transfusion be considered in hospitalized patients with anemia?
Transfusion is considered in hemodynamically unstable patients or those with hemoglobin <7 g/dL in the ICU.
What does a high RDW typically indicate in anemia?
A high RDW is commonly seen in reticulocytosis.
What are target cells on a peripheral smear indicative of?
Target cells are indicative of conditions such as thalassemia, hemoglobinopathies, and liver disease.
What is the significance of a positive Direct Coombs test?
A positive Direct Coombs test indicates autoimmune hemolytic anemia.
